This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Sunday, 18 October 2009

Coming back to the bedside: Nurse Amnesia

I really like Nurse Ratchet and her most recent blog post really struck a chord with me.

Ok, so I've had a wake up call. Last night I worked on the "Assessment/admissions/somewhere you go so you don't break the 4 hour target" ward. It's the first time in years that I haven't done my overtime either in A&E or my own team. And strangely enough I really enjoyed it - and realised how far removed I've become from real life. Jeez - it took me 'till 0300 hrs to catch up - they'd had such a busy day that pretty much every one of my patients (and I only had 5) had fluids running behind, IV AB's not given,hourly urines not done - not to mention the very demanding patient who was in tears as her fan had broken.

I have to say that I neglected her, and her "lesser" needs to sort out the chap with neutropaenic sepsis, and the woman I had going to Theatre for a laparotomy, and the ALD with the pump that kept turning off, meaning her drug regime was about 6 hours behind. Bloody hell it's hard. I left the demanding patient for an unacceptable amount of time while I dealt with my poorly patients, but managed to catch up, as I said, by the morning.It's really really hard to work in these places, not helped, I am sure, by my lot telling you that you have to churn the patients out, and get them in. I saw some really good examples of good nursing last night, my hat is firmly off.I am eternally glad that I have done my time in these places, and that I actually don't need to spend every day going home handing over everything I haven't done anymore, because there hasn't been time.It's a scary old place, and it's only September.

Nurse Ratchet had 5 patients.

I am glad that Nurse Rachet enjoyed her shift and I am glad that she go her "wake up call". I think that many other senior decision makers in the NHS need to get a similiar wake up call.

It is damn hard to work on the frontlines. People do forget just how bad it is on the wards. It's similar to the kind of amnesia you get post childbirth. While you are in the throes of a 40 hour labour with a breech baby and no anaesthetist to do an epidural or c section ...well it is so bad that you want to die. You lose your mind from the pain and wonder just who the hell is doing all that screaming.

But a few months after the delivery you are telling your pregnant friends that "it's not that bad". And you cannot remember what it felt like. Your husband remembers and practically needs therapy and a shrink after watching you go through that, but you cannot remember much at all. Then when baby number two comes along and those intense contractions begin again you finally remember how bad it is and wonder what the hell made you do this again. "Oh shit here we go, what the fuck was I thinking? How could I forget this pain".

People who haven't been on the wards in awhile not only have nursing amnesia but they don't realise all the changes in healthcare delivery and pace that have taken place. Our site/bed /nurse managers have long forgotton just how hard it all is, and unlike Nurse Rachet, they will not be returning for a shift to find out. Site managers and bed managers are trying to work with what they have as far as staffing goes. It's the folks above them that are making all the bad decisions, and many of them are former nurses. They are all suffering from nurse amnesia. They are incapable of making intelligent staffing decisions. Their minds are on budgets.

I remember my last maternity leave. I stopped into work with my beautiful new baby to show him off while I collected my post. I looked around the ward and thought things like "this doesn't look to bad" "They don't look crazy busy " and "Why the hell was I so stressed when I did this".

I came back from maternity leave ready to go, ready to be supernurse and really believing that the little voice in my head who told me to brace myself was my mind playing tricks on me......nah...it won't be that bad!!! My first day back after 6 months was as the sole RN for 24 medical beds. And it got steadily worse from there. It wasn't until I came back that I actually remembered just how bad it truly is on a short staffed ward.

But we do not allow the bedside nurses (including sisters) to have any kind of say in how the wards are staffed and run even though they are the only ones who could do so intelligently. The only "nurses" who get to have a say are the ones who left bedside care years and years ago and whose main priority is making friends with the business managers.

9 comments:

Anonymous
said...

Nurse Anne I share your irritation over nurse managers. The answer is generally the people in those positions know only how to take / implement orders.They often don't have the skills or nouse or will,to ruffle feathers upwards.Or perhaps they need to hang on to their jobs.

She did a shift on the ward. She was the only good matron I ever knew. She covered shifts when we were short.

One day she worked an evening shift as the sole RN for 15 patients. At the end of the shift she was shaking her head and saying "this is impossible".

She was very outspoken on our behalf. She was one of three matrons. The powers that be decided to downgraded to two matrons and made them all reapply for their posts. Our good matron was the one who lost her job.

In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.